Practice of Hand Washing in Health Institutions - Term Paper Example

Topic: Implementation of evidence-based practice of hand washing in Health Institutions Name: Student ID: Institution name: Tutor’s Name: Due Date: Introduction There is concern among all heath workers in every health institutions to ensure overall healthy conditions in the health facility. Infections have been prevented by use of a range of methods of cleaning hands to prevent infections such as alcohol and hand rubbing methods. These modern methods are quite different from other methods where hand washing with soap was the main form of hand cleaning to prevent infections (Grol & Grimshaw, 2003). Due to the popularity of the use of alcohol-based cleaning method for cleaning hands, it has been necessary to know the effectiveness of this approach in prevention of infections in comparison with hand washing method. According to (Subash, 2004), when hands are rubbed with alcohol based reagents, health workers are less likely to cause infections as a result of handling patients with hands that contain germs. The idea of the use of alcohol rub for hand cleaning purposes has also been supported by (Thurston & King, 2005) who explains that it results into a reduction in contamination in comparison with the use of soap and water during hand cleaning process. This paper provides a plan that can be used to implement hand hygiene at King Fahad Hospital as well as providing a discussion of barriers and facilitators for change in implementation of the practice, as well as providing an evaluation process that will enable stakeholders determine the effectiveness of the strategy. A model for implementation of evidence-based practice in hand hygiene activities in King Fahad Hospital in Saudi Arabia There exist a wide range of models for change that can be implemented to ensure change is realized in a particular practice in an organization. An example of such a model is the Lewin’s model for change that is generally composed of three phases (Haynes & Haines, 1998). Other models that can be used to implement change with regards to evidence-based practice include the Stetler model, Rosswurm and Larrabee model of 1999 and Kitson’s model (Shapiro, 2007). This model is important in managing change of hand cleaning culture in King Fahad Hospital because it provides the employees to resists conditions that could result into lack of attainment of change by explaining the processes involved in attaining change. However, Stetler model, Rosswurm model or Kitson’s model do not provide a guide into these steps but simply provide actions that need to be taken to bring change without explaining the order in which they should be done (Grol & Grimshaw, 2003). This is more appropriate in comparison with other methods of attaining change in the organization such as at King Fahad hospital where there is the need to bring changes in hand cleaning practices by adopting a new method of hand hygiene among health workers (Johnson, 2009). The following are the steps that are followed in this model. Unfreeze In this stage of effecting change, the organization concerned ensures status quo is prevented by overcoming conditions that result into this state such as mindset of employee and policies (Melnyk & Fineout-Overholt, 2005). It involves making employees in the organization aware of the need for change and develops new solutions for the current problems experienced in the organization. This step can be applied in creating change in hand washing practices at King Fahad hospital by educating employees about the significance of using other methods of hand washing a part from the use of soap and water (Grimshaw, Eccles & Tetroe, 2004). The employees can also be educated about the disadvantages of current practices in hand washing by stating the disadvantages of current practices such as contribution to infections and the need to avoid the use of current practices in hand washing (Coiera, 2001). Transition In this stage of Lewin’s model, new practices, attitudes and values are developed through making changes in the structure of the organization and coming up with development techniques (Mohide & King, 2003). It may be accompanied with periods of confusion during the transition process from the old ways to new ways of practices and organizations need to be aware of this condition. In order to apply this phase in management of change at King Fahad Hospital, the personnel in control of the nursing department will inform other nurses about changes that have been developed in hand washing practice through the use of notice boards and staffs meetings. They can also be informed about the current disadvantages of existing methods of hand cleaning as a result of use of other methods of hand cleaning (Oredsson et al. 2011). They can then be introduced to alcohol based method of hand cleaning and its advantages in reducing infections and other benefits it brings to health workers and patients. At this stage, employees who are ready to follow the new directives and those who are reluctant to change will be identified. Fast followers will be selected to provide guidance to other nurses to ensure they are convinced about the advantages of the selected form of hand washing practice and able to apply them in management of their cleaning activities. At King Fahad Hospital, the step of change will involve introduction of the proposed hygiene at the hospital. Freeze This is the stage of crystalizing and adapting new change of practice in the organization. There is the need to be aware of the possibility of reverting to older practices and develop mechanisms of preventing this condition (Rosswurm & Larrabee, 1999). For instance, some nurses at King Fahad hospital may be unwilling to change from old methods of hand washing and refuse to adopt new techniques of hand washing. It also involves conducting change evaluation of the benefits associated with change by evaluating improvements in conditions at the organization as a result of these changes (Mohide & King, 2003). Barriers and facilitators for the change of practice There are a number of barriers that will affect successful attainment of suggested hand cleaning technique at King Fahad hospital in Saudi Arabia. There exist a number of barriers that prevent change such as the attitude of practitioners towards the use of alcohol-based hand washing reagents as well as the work load that would cause some workers to avoid washing their hands during their work (Shapiro, 2007). In addition, it would be difficult to include all employees into the change of practice at the hospital. This is because some employees would be assigned to external tasks or on a holiday and would not be available during the training process. There are a number of ways in which these barriers could be overcome. These include providing employees with re-education programs to prepare them for change of hand hygiene practices at the hospital (Shapiro, 2007). The barrier of unavailability of employees of the hospital can be overcome by providing training on hand cleaning practices based on a particular turn where training is done on a particular time later or send it by email to ensure all employees get time to be trained on the newly introduced strategies of hand cleaning (Rosswurm & Larrabee, 1999). There is also the lack of facilities in most hospitals and it has been difficult to get facilities for attaining change (Subash, 2004).This barrier could be overcome by planning in advance and allocating finances for purchasing facilities to be used during the training process. Facilitators will contribute significantly towards accomplishment of the goals of the new practices in hand washing at the hospital (Oredsson. et al. 2011). This is because of the performance of tasks that ensure the success of the new practices at the hospital. Some of the facilitators will be hospital administrators who will contribute by working with other individuals and coordination of plans with the goal of implementing the strategies that include the requirements of the new practice in hand cleaning (Mohide & King, 2003). Other facilitators will be trainers in skills of hand washing who will provide the training in terms of equipment and materials used during hand cleaning process. Consequently, improvement of health care at King Fahad hospital will be improved if the administrators at the hospital implement this policy through provision of adequate funding and resources. Stakeholders The main stakeholders in this paper will be the community surrounding the hospital who may seek the services of the hospital, practitioners at the hospital who will provide health care at the hospital. Other stakeholders will be members of the nursing health unit who will assist in provision of services such as research services and financial assistance to the organization during implementation of the new practice (Melnyk & Fineout-Overholt, 2005). Another stakeholder will be the head of nursing department whose role will be ensuring effective functioning of groups and attainment of the new hand cleaning strategy. In this case the key stake holders will be Community Infection Control Nurses, General Practitioners and the Consultant Microbiologist chosen according to clinical proficiency and commitment to best practice. Added to that, it will contain members with methodological expertise and guidelines appraisal skills such as a Senior Researcher and a Health Economist all without conflict of interests (Coiera, 2001). A nurse group leader, project director and chairperson will be assigned in order to ensure that the group is functioning effectively and is achieving the aim. Strategies There are a number of strategies that can be implemented to promote implementation of new policies in hand cleaning at the hospital. These strategies are diverse and based on a number of factors that affect the type of strategy used (Grol & Grimshaw, 2003). For instance, the strategy used will be affected by the types of health problems that the model seeks to address and the systems existing in the organization that can be used to accomplish the implementation of the new strategy. In this paper, the strategy that will be used to address the form of hand cleaning technique that should be used at the hospital will be the audit and feedback strategy due to its cost effectiveness in comparison with other strategies and its ability to be conducted within a short duration (Rycroft-Malone et al, 2004). In addition, this method will be used because it provides an illustration of various hands washing techniques in terms of their ability to prevent infections and getting the best method of preventing infections in hospitals such as the use of water and soap or the use of alcohol hand rubbing techniques among other methods (Rycroft-Malone et al, 2004). In auditing and feedback strategy, a study will be conducted at the hospital during which various methods of hand cleaning will be introduced (Johnson, 2009). Nurses will be asked to identify the type of hand cleaning method that has the least cases of infection. They will also be asked to name the hand cleaning technique they prefer in place of other hand cleaning techniques. The techniques of hand washing will be ranked based on the number of health workers preference to use them (Aacharya, 2011). The hand washing method that is preferred by the largest number of nurses during hand cleaning process will be determined by comparison with other hand cleaning processes and selected for implementation at the hospital. Evaluation Steps in the evaluation process In order to determine if the plan has worked, evaluation will be done at the end of training and the beginning of implementation of the new strategy in hand washing by determining whether the nurses are implementing the new strategy in hand washing (Elkum, Fahim, Shoukri & Al-Madouj, 2009). The effectiveness of various methods of hand washing in preventing infections will be determined by establishing whether any infections are experienced when they are used during cleaning hands during activities at the hospital. Evaluation of strategies that worked will be done by determining the ability of nurses to use various methods of hand washing that was introduced during the training process (Grimshaw, Eccles & Tetroe, 2004). Strategies that did not work will be determined by establishing whether the nurses find difficulties in using them during hand washing activities at the hospital. A plan to evaluate is needed because it ensures all factors that affect the implementation of the new hand washing strategy are determined and conditions that prevent attainment of the objectives of hand washing are determined during the evaluation process (Grol & Grimshaw, 2003). According to (Levin and Feldman 2006, p. 311) evaluation process will involve identification of various techniques of hand washing and the variables associated with them such as infections associated with the hand washing technique. This will be followed by determining methods of data collection for establishing various hand cleaning methods that have been used to handle patients of various ages (Johnson, 2009). The findings will be presented by constructing charts from which the data will be analysed in terms of infections caused when various hand cleaning techniques are used. Validity of the data collected from the audit process will be established such as content validity (Maas & Johnson, 1998). Data collectors will be educated on the relevant data that need to be collected during the audit process. Inter-rater reliability will be determined by assessing whether the data collected actually represented the conditions that exist in the hospital. Data will be collected at specified interval such as on weekly basis. The data collected can include various methods of hand cleaning, infections associated with these methods and the percentages of infections associated with various hand washing methods (Mohide & King, 2003). Staffs will be asked to provide feedback regarding the effectiveness of the new strategy of hand cleaning at the hospital and the data will be used to assist in modification of new hand cleaning practice in the hospital. Conclusion Hand cleaning practice in hospitals is still a major difficulty faced by many workers in health institutions such as hospitals. It is necessary to ensure hospitals determine the best methods of cleaning hands that ensures employees observe the regulations during their practices at the hospitals. By ensuring hands are washed, it is possible to prevent a number of infections related to unclean hands when patients are provided with health services. In addition, it is necessary to ensure health practitioners are provided with training on effective hand cleaning methods and apply them during their services to patients. The training needs to be implemented and evaluated to determine any difficulties experienced during its implementation and action taken to overcome the difficulties to ensure the success of the implementation process.This paper shows that research needs to be done to determine the best method of hand cleaning and recommends that hospitals should consider hand cleaning as an important practice in medical practice. References Levin, R. F., & Feldman, H. R. (Eds.). (2006). Teaching evidence-based practice in nursing. New York: Springer Publishing. Aacharya, Ramesh P (2011). Emergency department triage: an ethical analysis. BMC Emergency Medicine, 11 (1), p. 16. Coiera, E. (2001). Maximising the uptake of evidence into clinical practice. Medical Journal of Australia, 174, 467-470. Elkum, Naser (2011). Canadian Emergency Department Triage and Acuity Scale: implementation in a tertiary care centre in Saudi Arabia. BMC Emergency Medicine, 11 (1), p. 3. 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